Human immunodeficiency virus associated tuberculosis more often due to recent infection than reactivation of latent infection
RMGJ Houben, AC Crampin, R Ndhlovu… - … of tuberculosis and …, 2011 - ingentaconnect.com
RMGJ Houben, AC Crampin, R Ndhlovu, P Sonnenberg, P Godfrey-Faussett, WH Haas…
The international journal of tuberculosis and lung disease, 2011•ingentaconnect.comBACKGROUND: It is unclear whether human immunodeficiency virus (HIV) increases the
risk of tuberculosis (TB) mainly through reactivation or following recent Mycobacterium
tuberculosis (re) infection. Within a DNA fingerprint-defined cluster of TB cases, reactivation
cases are assumed to be the source of infection for subsequent secondary cases. As HIV-
positive TB cases are less likely to be source cases, equal or higher clustering in HIV-
positives would suggest that HIV mainly increases the risk of TB following recent infection …
risk of tuberculosis (TB) mainly through reactivation or following recent Mycobacterium
tuberculosis (re) infection. Within a DNA fingerprint-defined cluster of TB cases, reactivation
cases are assumed to be the source of infection for subsequent secondary cases. As HIV-
positive TB cases are less likely to be source cases, equal or higher clustering in HIV-
positives would suggest that HIV mainly increases the risk of TB following recent infection …
BACKGROUND
It is unclear whether human immunodeficiency virus (HIV) increases the risk of tuberculosis (TB) mainly through reactivation or following recent Mycobacterium tuberculosis (re)infection. Within a DNA fingerprint-defined cluster of TB cases, reactivation cases are assumed to be the source of infection for subsequent secondary cases. As HIV-positive TB cases are less likely to be source cases, equal or higher clustering in HIV-positives would suggest that HIV mainly increases the risk of TB following recent infection.
METHODS
A systematic review was conducted to identify all studies on TB clustering and HIV infection in HIV-endemic populations. Available individual patient data from eligible studies were pooled to analyse the association between clustering and HIV.
RESULTS
Of seven eligible studies, six contributed individual patient data on 2116 patients. Clustering was as, or more, likely in the HIV-positive population, both overall (summary OR 1.26, 95%CI 1.0–1.5), and within age groups (OR 1.50, 95%CI 0.9–2.3; OR 1.00, 95%CI 0.8–1.3 and OR 2.57, 95%CI 1.4–5.7) for ages 15–25, 26–50 and >50 years, respectively.
CONCLUSIONS
Our results suggest that HIV infection mainly increases the risk of TB following recent M. tuberculosis transmission, and that TB control measures in HIV-endemic settings should therefore focus on controlling M. tuberculosis transmission rather than treating individuals with latent M. tuberculosis infection.
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